Predictors of Medically Serious Suicide Attempts: A Case–Control Study in Patients Admitted to a General Hospital Over Eight Years

Abstract

Background and Objectives: A medically serious suicide attempt (MSSA) has been defined as a suicide attempt that would be fatal if not for medical intervention. Despite the seriousness of MSSA, the risk factors are only partially understood. The main aims of the present study were to define the characteristics of patients admitted to a general hospital for MSSA and to identify the predictors of MSSA.

Methods: Prospective, observational case-control study involving adult inpatients admitted to non-psychiatric units at our institution and consecutively referred to the consultation-liaison psychiatry (CLP) unit between January 1, 2011 and December 31, 2018. Cases were patients who met clinical criteria for MSSA and controls were patients referred to the CLP unit for any other reason. All participants underwent a structured psychiatric interview. Sociodemographic, clinical, and psychosocial data were collected. Univariate and multivariate analyses were performed. Variables that were statistically significant on the univariate analysis were entered into a multivariate binomial logistic regression model.

Results: A total of 5428 patients were included: 223 (4.1%) cases and 5205 (95.9%) controls. On the multivariate analysis, the variables significantly associated with the risk of MSSA were: younger age (odds ratio [OR] = 0.98); history of previous suicide attempts (OR = 17.41): psychosocial stressors (interpersonal problems, OR = 2.33; legal problems, OR = 3.38; multiple stressors, OR = 2.28); and presence of severe mental illness (schizophrenia, OR = 6.32; mood disorder, OR = 6.77; personality disorder, OR = 6.35).

Conclusions: The findings of this study highlight the importance of early identification of individuals who present with risk factors for MSSA to enable timely intervention. The prompt intervention of CLP services plays a key role in improving patient outcomes, underscoring the importance of specialized, comprehensive psychiatric care in this patient population.